Healthcare Provider Details

I. General information

NPI: 1669695029
Provider Name (Legal Business Name): SPORTS AND ORTHOPEDIC REHABILITATION, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 12/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 YOUNGFIELD ST SUITE 150
GOLDEN CO
80401-2263
US

IV. Provider business mailing address

2801 YOUNGFIELD ST SUITE 150
GOLDEN CO
80401-2263
US

V. Phone/Fax

Practice location:
  • Phone: 303-238-4277
  • Fax: 303-238-4977
Mailing address:
  • Phone: 303-238-4277
  • Fax: 303-238-4977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number20602
License Number StateCO

VIII. Authorized Official

Name: DOUGLAS E HEMLER
Title or Position: OWNER
Credential: MD
Phone: 303-238-4277